中文摘要
公共卫生系统在世界许多地区占据主导地位，但往往面临财政约束，导致医疗服务受到配给。因此，私营部门医疗服务提供者理论上可以有益地补充公共系统，但评估私营替代方案的收益一直颇具挑战。我们评估了一项针对全球最致命的健康问题之一——糖尿病——的私营补充服务，该服务补充了免费的公共卫生系统。我们估计，这项私营补充服务产生了巨大影响，使接受治疗者中病情得到控制的比例提高了69%。这一效应同时源于治疗依从性和健康行为的改善。我们发现糖尿病并发症在短期内有所下降，且该干预的净成本仅为总成本的三分之一。私营医疗的回报似乎并非源于更高效率的服务提供，而是源于患者与医疗服务建立了更紧密的联系，这为改进公共系统提供了启示。
Abstract
Abstract Public health systems are dominant in much of the world but often face fiscal constraints that lead to rationing of care. As a result, private sector healthcare providers could in theory beneficially supplement public systems, but evaluating the benefits of private alternatives has been challenging. We evaluate a private supplement to the free public health system for one of the world’s deadliest health problems, diabetes. We estimate enormous impacts of the private supplement, increasing the share of those treated who are under control by 69%. This effect arises through both improved treatment compliance and health behavior. We find diabetes complications fall in the short run, and that the net costs of this intervention are one-third of the gross costs. The returns to private care do not appear to reflect more productive delivery but rather more attachment to medical care, offering lessons for improving the public system.